DALLAS - Harold Boling built a career as a college registrar on his attention to detail. So when he found out he had Alzheimer's disease, he and his wife, Ginny, visited an attorney and a financial adviser.
"I wanted to make decisions about our future while I still could," he said. "I may have Alzheimer's disease, but it doesn't have me."
In the five years since his diagnosis, Boling has learned to take life a day at a time. The couple, in their 60s, sold their home and downsized to a comfortable apartment in Plano, Texas. He gave up driving but still enjoys walks around the neighborhood.
With help from his lawyer, Boling authorized his wife to manage the money after he becomes incapacitated. Though the two continue to discuss their finances, Boling pays the bills.
Half of the 5.1 million Americans with Alzheimer's are in the early stages of the disease, and many are still able to exercise some independence. As more emphasis is placed on early detection, the Alzheimer's Association has launched a program to help people like Boling plan for tomorrow.
Participants in the Trailblazers program meet weekly for two months to hear experts such as elder law attorneys and financial counselors talk about how to make the best of their illness.
"Some people put off making preparations, but those who do face the facts shortly after a diagnosis have a much greater say in their care," said Sydney Farrier, who oversees the program for the Alzheimer's Association in Dallas.
The first step, experts agree, is to ask a legal professional to draw up documents designating someone to make financial and personal decisions for the individual with Alzheimer's once the disease advances.
"This 'durable power of attorney' doesn't strip someone of his legal rights. It simply names an agent to help handle matters if the person can't or chooses not to," said Dallas attorney Michael Cohen.
Without that authority, a family might eventually need to go to court to have someone named as a legal guardian, a process that can be time-consuming and costly, he said.
As hard as it is for some couples or families to talk about money, a diagnosis of Alzheimer's makes it a necessity, said Gary Crooms, a financial gerontologist in Lewisville.
"Look at bank and brokerage statements, insurance policies, mortgage papers, outstanding bills, pension summaries and other retirement benefit updates," he said.
Locating those documents isn't always simple, especially if the person who's paid the bills and balanced the checkbook is the one with the diagnosis, said Suzanne Cobb, who runs a program that helps older adults manage their money at the Senior Source in Dallas.
"That search may require going through literally every drawer in the house," she said.
Shelly Newman of Plano, texas, had always deferred to her husband, Ray, on household financial matters, because he was an investment banker. But after he was diagnosed, she stepped in to manage the money.
She soon discovered that her husband had been quietly struggling for a while.
"Some bills had been paid twice. Others were long past due," Newman said. "Our mortgage lender had made a mistake on our refinancing that was never caught, and our monthly payments ballooned. There were also bad investment decisions."
She's trying to pay off old debts and contemplating the sale of their home to reduce their living costs.
Sometimes the person with Alzheimer's resists handing off the finances. In those cases, Farrier said, the financial caregiver might consider writing the checks but allowing the spouse or parent to sign them.
When Kathy Priester of Dallas sits down with her mother to go over the week's bills, she asks the elderly woman to sign the checks even if it extends the session by an hour.
"It takes patience, but it's worth it because she doesn't feel as though she's lost all control," Priester said.
Check-writing caregivers who are looking for ways to shorten their task should get invoices mailed directly to them and pay bills online, Crooms said.
Someone with Alzheimer's may require years of care that could cost hundreds of thousands of dollars, so a diagnosis needs to prompt a review of private insurance and government benefits, experts say.
"Many people mistakenly think Medicare will cover their long-term care bills, but it doesn't," Farrier said.
Those who were farsighted enough to buy private long-term care insurance before their diagnosis should check the terms of their coverage.
Older policies may pay for institutional care but not in-home care, said Greg Regan, a Dallas financial gerontologist.
"If you discover your coverage isn't adequate or you never bought protection, you still may be able to purchase an annuity that will provide a lifetime source of income," he said.
After his diagnosis at 59, Larry Maisel and his wife, Judith, sold the New Braunfels, texas, property where they had been building their dream house and moved to a loft in downtown Dallas to be near family.
Maisel checked with former employers to tap into pension benefits he qualified for. He also applied for disability insurance through Social Security.
"Signing up for disability was embarrassing because he had never asked for anything in his life," Maisel said.
But Crooms said no one with Alzheimer's should feel sheepish about seeking government benefits.
"They're not a handout. If you're entitled to the money, you'd be foolhardy not to use it," he said.
One frequently overlooked source of assistance, Regan said, is a veterans' "aid and attendance" benefit that can defray the cost of long-term care.
Wartime veterans and their surviving spouses can qualify for it, and they don't have to exhaust their assets as they must do before getting help from Medicaid with nursing home expenses, he said.
"It's a pleasant discovery for many," Crooms said. "The benefit pays between $12,000 and $22,000 a year."
Like others living with an early diagnosis of Alzheimer's, the Maisels say they're content with their new lifestyle and relieved they've done their legal and financial planning.
"There's no advantage to waiting," Maisel said. "It only makes matters worse, especially for family members left to guess what to do when the time comes to jump in. This way, we can focus on living each day to the fullest."
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TIPS FOR CAREGIVERS
Obtain "advance directives" that authorize you to help with financial and health care issues.
Review one year of bank statements to get an accurate picture of your parent's or spouse's income and expenses.
Arrange for all income to be deposited electronically.
Pay recurring bills online.
Check whether your parent or spouse can get cash from a life insurance policy to defray the cost of care.
Check eligibility for Medicare, Medicaid, Social Security disability, veterans' benefits and other government assistance.
Seek out professional advisers such as elder law attorneys, financial gerontologists and geriatric care managers.
SOURCE: Gary Crooms, Senior Information Services, Lewisvill
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(c) 2008, The Dallas Morning News. Distributed by Mclatchy-Tribune News Service.